Myocardial revascularization with and without cardiopulmonary bypass in multivessel disease: Impact of the strategy on early outcome

Background. The impact of myocardial revascularization without cardiopulmon ary bypass (CPB) was evaluated in a series of consecutive patients with mul tivessel disease. Methods. From May 21, 1997 to November 30, 2000, 1,843 consecutive patients underwent isolated myocardial revascularization. From this total, 919 pati ents were done without CPB (group A. 49.9%) and 924 patients were done with CPB (group B. 50.1%). Patients that converted from without CPB to with CPB were included in group A. Thirty-three variables were evaluated with univa riate and multivariate analysis to identify the independent variables predi ctive of higher incidence of early mortality, acute myocardial infarction, cerebrovascular accident, and early major events. Results. Early mortality was 2.2% (group A. 1.4%; group B, 3.0%; p = 0.016) , acute myocardial infarction incidence was 1.8% (group A, 1.1%; group B, 2 .6%; p = 0.027), cerebrovascular accident incidence was 0.9% (group A, 0.8% ; group B, 1.0%; p = not significant), and early major events incidence was 6.7% (group A, 5.3%; group B, 8.2%; p < 0.001). Stepwise logistic regressi on analysis showed that CPB was an independent risk factor for higher morta lity (odds ratio, 2.2; p = 0.0217), higher incidence of acute myocardial in farction (odds ratio, 2.5; p = 0.0185), and higher incidence of early major events (odds ratio, 1.8, p = 0.0034). Conclusions. When CPB was not used, patients experienced lower early mortal ity and incidences of acute myocardial infarction were less complicated, bo th at univariate analysis and stepwise logistic regression analysis. (C) 20 01 by The Society of Thoracic Surgeons.